Medicare Guide to your stay at Emerson Health and Rehabilitation Center.
What is Medicare?
Medicare is a federal health insurance entitlement program over seen by the Secretary of Health and Human Services and administered by the Health Care Financing Administration (HCFA).
Does Medicare cover the expense of staying at Emerson Health and Rehabilitation Center?
In order for your rehabilitation stay to be covered by Medicare, you must be entitled to Part A of Medicare and have been in the hospital as an inpatient for at least three overnight stays. At Emerson Health and Rehabilitation Center, we will work with your hospital and your physician to make sure that your stay is covered under the following Medicare guidelines:
Placement in a skilled nursing facility is the most appropriate care.
Skilled services must be ordered and certified by a physician.
Skilled nursing and / or skilled rehabilitation services must be necessary and provided on a daily basis.
How does Medicare work?
Part A: Hospital Insurance
Skilled services must be reasonable and necessary for the condition that was treated during the hospital stay or condition that arose in a skilled nursing facility while being treated for a condition that was previously treated in a hospital.
The skilled nursing facility must admit the patient within 30 days of hospital discharge, and admission must relate to the condition that made the hospital stay necessary.
Days must be available in the current Benefit Period.
- Medicare uses a period of time called a Benefit Period to keep track of how many days of SNF benefits you use, and how many are still available. A benefit period begins on the day you start using the SNF benefit under Part A of Medicare. You can get up to 100 days of skilled nursing services or rehabilitation.
- Your benefit period ends.
- When you have not been in a skilled nursing facility for at least 60days in a row or
- If you remain in a SNF when you haven’t received skilled care there for at least 60 days in a row
- There is no limit to the number of benefit periods you can have. However, once a benefit period ends, you must have another 3-day qualifying stay and meet the Medicare requirements before you qualify for another 100 days of skilled nursing benefits.
- The first 20 days of the benefit period are fully covered by Medicare.
- The remaining 80 days have a co-payment. Many secondary insurance companies will often cover this deductible.
Services that Medicare Part A helps to pay for while in a skilled nursing facility:
Semi-private room
All meals, including any special dietary needs
Skilled nursing care
Physical, occupational, and speech therapy services
Medical social services
Medications
Medical supplies and equipment used in facility
Dietary counseling
Non-Covered Services
Non-skilled or custodial care
Personal convenience items
Private duty nurses
Private room fees, except when a physician certifies that a private room is medically necessary
Part B: Medical Insurance
Eligibility Requirements
Medicare B is voluntary. Anyone entitled to Medicare Part A benefits can enroll in Medicare Part B. The program has a monthly premium, annual deductibles and co-insurances. Most United States residents who are age 65 or older can enroll in Part B coverage without having Part A.
Physician services
Outpatient hospital services and certain medical supplies, drugs and biologicals (vaccines, serums)
Outpatient physical therapy, including occupational and speech
Diagnostic testing (x-rays and lab tests)
Durable medical equipment
Certain prosthetic services
Surgical dressings, splints and casts
Parental and internal nutrition
Certain vaccines including Hepatitis B and Influenza (flu)
Non-covered services include:
Routine physical examinations and related tests
Routine podiatry services and dental care
Examinations to prescribe or fit eyeglasses or hearing aids
Most immunizations, prescription drugs or cosmetic surgery, unless needed because of accidental injury or to improve function
